Comparing the efficacy of tocilizumab with corticosteroid therapy in treating COVID-19 patients: a systematic review and meta-analysis

Abstract

Purpose Tocilizumab has shown equivocal outcomes in reducing mortality in COVID-19. The corticosteroids appear to be an affordable alternative to tocilizumab. This study aims to estimate the efficacy of tocilizumab and the corticosteroids particularly dexamethasone and methylprednisolone and to identify possible determinants of their efficacy. Methods Five electronic databases were searched for studies involving tocilizumab, dexamethasone, and methylprednisolone in treating COVID-19. We included case–control and randomized or partially randomized trials. Meta-regression for patient baseline characteristics, co-medications, and tocilizumab dose regimens was performed to identify contributing factors to drug efficacy. Results Thirteen randomized controlled trials (RCTs) and twenty-four case–control studies were included in our meta-analysis involving 18,702 patients. Meta-analysis among the RCTs showed that a summary estimate favoring mortality reduction (OR 0.71, 95%CI 0.55 – 0.92) contributed mainly by tocilizumab and dexamethasone. Among case–control studies, meta-analysis showed mortality reduction (OR 0.52, 95%CI 0.36 – 0.75) contributed by tocilizumab and tocilizumab-methylprednisolone combination. Methylprednisolone alone did not reduce mortality except for one study involving high dose pulse therapy. Meta-analysis also found that all three drugs did not significantly reduce mechanical ventilation (OR 0.72, 95%CI 0.32 – 1.60). Conclusion Tocilizumab and dexamethasone emerge as viable options in reducing mortality in severe COVID-19 patients. A tocilizumab-corticosteroid combination strategy may improve therapeutic outcome in cases where single therapy fails. Graphical abstract

Tocilizumab Outcomes in Critically Ill COVID-19 Patients Admitted to the ICU and the Role of Non-Tocilizumab COVID-19-Specific Medical Therapeutics

“…Mikulska et al was an early study that provided a hint of the favorable outcome of the combined therapy of steroids with tocilizumab, in which the methylprednisolone + tocilizumab treatment arm demonstrated a superior outcome in averting death and intubation compared to single therapy arms [ 28 ]. A recently published systematic review and meta-analysis by Lim et al showed that the concurrent use of a corticosteroid such as methylprednisolone was a significant influencer of tocilizumab efficacy in reducing mortality and improving survival [ 29 ]. This is especially visible in the excellent outcomes demonstrated by the CHIC study, which used 3–6 days of methylprednisolone in combination with tocilizumab in the late stages of the disease [ 30 ].…”

COVID-19 Case Management Outcomes Amongst Diabetes and Hypertensive Patients in the United Arab Emirates: A Prospective Study

“…Stone and colleagues’ [ 96 ] double-blinded study failed to detect the benefit or harm of the use of Tocilizumab in COVID-19 patients, which is not part of our study to analyze the impact of Tocilizumab specifically on patient outcomes. On the other hand, Lim et al [ 97 ] showed that a combination of Tocilizumab and Dexamethasone is effective in reducing mortality in severe COVID-19 infections where single therapy fails. However, the study of Lim et al [ 97 ] did not include the effect of diabetes in COVID-19 management with Tocilizumab and Dexamethasone.…”

“…On the other hand, Lim et al [ 97 ] showed that a combination of Tocilizumab and Dexamethasone is effective in reducing mortality in severe COVID-19 infections where single therapy fails. However, the study of Lim et al [ 97 ] did not include the effect of diabetes in COVID-19 management with Tocilizumab and Dexamethasone.…”

Therapeutic trials in difficult to treat steroid sensitive nephrotic syndrome: challenges and future directions

“…The Randomised Evaluation of COVID-19 Therapy (RECOVERY) trial is an adaptive platform trial assessing multiple interventions for patients hospitalized with COVID-19 in the UK. The trial began in early 2020 and has identified several effective (dexamethasone, tocilizumab and casirivimab/imdevimab) and six ineffective treatments [102][103][104]. This is a remarkable achievement in 2 years and illustrates the potential of platform trials to rapidly produce high-quality data and adapt to new medications as they become available.…”